Employment

Employment Application

Thank you for your interest in applying! All positions are currently filled. We will keep any applications on file for future opportunities.

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Name *

First

Last

Address (Street Address, Town/City, State) *

information please Address

Phone Number *

Email *

Certification Level *— Select Choice —EMT-BasicEMT-AdvancedParamedic

MA EMT/Paramedic Certification Number *

NREMT Certification Number *

Do you have a valid driver's license & reliable transportation? *— Select Choice —YesNo

Please list any additional EMS certifications (TECC, PHTLS, AMLS, etc). Please include certification numbers and expiration dates.

How many hours are you looking for? *— Select Choice —Full Time (32+/week)Part Time (16-32/week)Per Diem (min 16/month)

Shift Availability *

• Sunday
• Monday
• Tuesday
• Wednesday
• Thursday
• Friday
• Saturday
• I am on a rotating schedule with another agency

Hours/shifts will be discussed during initial interview.

Preferred Shift(s) – Select all that apply *

• Day Shift (08:00-16:00 or similar)
• Evening Shift (16:00-00:00 or similar)
• Overnight Shift (00:00-08:00 or similar)
• Daytime 12hr (08:00-20:00 or similar)
• Overnight 12hr (20:00-08:00 or similar)
• Any/no preference

EMS experience level: *— Select Choice —New Provider – 2 years2-5 years5-10 years10+ Years

Please describe past work experience (3 most recent preferred). Include contact information for previous/current employers if we may contact them. *

Were you referred to us? If so, please specify here. *

Have you been employed by the West Brookfield Rescue Squad in the past? If so, when? *

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize West Brookfield Rescue Squad, Inc. to contact former employers regarding my employment. I authorize my former employers to fully and freely communicate information regarding my previous employment, attendance, and professionalism. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment. *

• Agree

Electronic Signature & Date *

Submit